Individual
SHAWNECE LASHAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10632 BLUE HERON DR, ORLAND PARK, IL 60467-5489
(708) 910-8272
Mailing address
10520 S PEORIA ST, CHICAGO, IL 60643-3026
(773) 226-1712
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005295
IL
Other
Enumeration date
01/31/2024
Last updated
01/31/2024
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